Prognostic Classification of Histopathologic Response to Neoadjuvant Therapy in Esophageal Adenocarcinoma
Prognostic Classification of Histopathologic Response to Neoadjuvant Therapy in Esophageal Adenocarcinoma
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DOI：
10.1097/sla.0000000000000964
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发表时间：
2014-11-01
影响因子：
9
通讯作者：
Bollschweiler, Efriede
中科院分区：
文献类型：
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作者：
Hoelscher, Arnulf H.;Drebber, Uta;Bollschweiler, Efriede
目的：根据对预后的影响，评价食管腺癌新辅助治疗的组织病理学反应，并提出临床routine.Background分类：食管癌新辅助治疗的组织病理学反应的措施，如Mandard肿瘤消退分级集中在对原发肿瘤的影响。虽然淋巴结浸润是显着的预后重要性，这一标准大多不包括在响应classification.Methods：共370例（89%男性，中位年龄：61岁）与新辅助放化疗（40戈伊，5-FU，顺铂）或化疗（MAGIC或FLOT）cT 3，Nx，M0食管腺癌被纳入分析。所有患者均接受了经胸整块食管切除术，平均切除淋巴结27个，R 0切除率为92%。根据原发性肿瘤中少于或多于10%的活细胞，组织学回归分级区分主要或次要缓解。结果：从R 0切除组和M0组患者中，可将5年生存率（5-YSR）分为3组：1.主要缓解和ypN 0（n = 100），5-YSR为64%2。主要缓解和ypN+（n = 34）5-YSR 42%或次要缓解和ypN 0（n = 84）5-YSR 44%，共42% 5-YSR 3。结论：原发肿瘤消退和淋巴结状态的3级联合分类是食管腺癌新辅助治疗效果的一种简单且可重复的预后分类。
Objectives: To evaluate the histopathologic response to neoadjuvant therapy in esophageal adenocarcinoma according to impact on prognosis and to suggest a classification for clinical routine.Background: Measures of histopathologic response to neoadjuvant treatment of esophageal cancer such as Mandard tumor regression grading focus on the effect on the primary tumor. Although lymph node infiltration is of significant prognostic importance, this criterion is mostly not included in the response classifications.Methods: A total of 370 patients (89% males, median age: 61 years) with neoadjuvant radiochemotherapy (40 Gy, 5-FU, cisplatin) or chemotherapy (MAGIC or FLOT) for cT3, Nx, M0 esophageal adenocarcinoma were included in the analysis. All patients had undergone transthoracic en bloc esophagectomy, with a median of 27 resected lymph nodes and a R0-resection rate of 92%. Histopathologic regression grading differentiated major or minor response according to less or more than 10% vital cells in the primary tumor. The lymph nodes were classified as ypN0 or ypN+.Results: From the patients with R0 resection and M0 category, 3 groups with significantly different 5-year survival rates (5-YSR) could be differentiated:1. Major response and ypN0 (n = 100) with 5-YSR of 64%2. Either major response and ypN+ (n = 34) 5-YSR 42% or minor response and ypN0 (n = 84) 5-YSR 44%, together 42% 5-YSR3. Minor response and ypN+ (n = 111) and 5-YSR of 18%.Conclusions: A combined classification of primary tumor regression and lymph node status in 3 grades represents a simple and reproducible prognostic classification of the effect of neoadjuvant treatment in esophageal adenocarcinoma.